title: Fibrin glue for closure of conjunctival incision in strabismus surgery: a report by the american academy of ophthalmology.
abstract: OBJECTIVE
  To evaluate the severity of postoperative inflammation, degree of patient discomfort, adequacy of wound closure, and length of operating time when using fibrin glue compared with sutures to close limbal conjunctival incisions after strabismus surgery.
  
  
  METHODS
  Literature searches of the PubMed and Cochrane Library databases were last conducted on January 24, 2013, and resulted in 24 citations, including 2 not in the English language. All citations were reviewed in full text. Five studies compared fibrin glue (68 eyes) with sutures (74 eyes) for closure of limbal conjunctival incisions in patients undergoing strabismus surgery and were included in this assessment; no studies were found that evaluated fornix incisions. A quality rating was assigned to each study using criteria specifically developed for this assessment.
  
  
  RESULTS
  No level I studies were found, and 5 level II studies were identified. There was significantly less postoperative inflammation and patient discomfort for 1 to 3 weeks after strabismus surgery for eyes treated with fibrin glue compared with sutures. In 3 studies that evaluated wound apposition, 2 of 50 eyes (4%) with conjunctival incisions that were initially closed using fibrin glue subsequently developed a wound gap that required suture repair. In the 2 studies that compared surgical time, fibrin glue required 1 to 5 minutes less time than suturing in 1 study and 55% less time (3.8 vs. 8.4 minutes) in a second study. These 5 studies did not evaluate the cost-effectiveness or risk of viral transmission from fibrin glue.
  
  
  CONCLUSIONS
  Studies in the literature suggest that the off-label use of fibrin glue to close limbal conjunctival incisions in strabismus surgery resulted in less postoperative inflammation and required shorter operating time compared with sutures, but it increased the percentage of wounds requiring subsequent repair with sutures.
  
  
  BACKGROUND
  The author(s) have no proprietary or commercial interest in any materials discussed in this article.
authors.affiliation: Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, Department of Ophthalmology, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Yang
authors.forename: Michele
authors.initials: M
authors.lastname: Melia
authors.forename: Scott R
authors.initials: SR
authors.lastname: Lambert
authors.forename: Michael F
authors.initials: MF
authors.lastname: Chiang
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Simpson
authors.forename: Angela N
authors.initials: AN
authors.lastname: Buffenn
mesh_terms: D000047:Academies and Institutes; D003228:Conjunctiva / Q000601:surgery*; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D007249:Inflammation / Q000188:drug therapy; D009885:Ophthalmology; D017060:Patient Satisfaction; D011183:Postoperative Complications; D013285:Strabismus / Q000601:surgery*; D013536:Suture Techniques; D013673:Technology Assessment, Biomedical; D014014:Tissue Adhesives / Q000627:therapeutic use*; D014481:United States; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives